title: Predicting portal hypertension and variceal bleeding using non-invasive measurements of metabolic variables.
abstract: OBJECTIVE
  This study assessed the involvement of metabolic factors (anthropometric indices, insulin resistance (IR) and adipocytokines) in the prediction of portal hypertension, esophageal varices and risk of variceal bleeding in cirrhotic patients.
  
  
  METHODS
  Two prospective and retrospective cohorts of cirrhotic patients were selected (n = 357). The first prospective cohort (n = 280) enrolled consecutively in three centers, underwent upper gastrointestinal endoscopy, seeking evidence of esophageal varices. Clinical, anthropometric, liver function tests, ultrasonographic, and metabolic features were recorded at the time of endoscopy, patients were followed-up every 6 months until death, liver transplantation or variceal bleeding. The second retrospective cohort (n = 48 patients) had measurements of the hepatic venous pressure gradient (HVPG). Statistical analyses of the data were with the SPSS package.
  
  
  RESULTS
  The presence of esophageal varices was independently associated with lower platelet count, raised HOMA index and adiponectin levels. This relationship extended to subset analysis in patients with Child A cirrhosis. HOMA index and adiponectin levels significantly correlated with HVPG. Beside Child-Pugh class, variceal size and glucagonemia, HOMA index but not adiponectin and leptin plasma levels were associated with higher risk of variceal bleeding.
  
  
  CONCLUSIONS
  In patients with cirrhosis, HOMA score correlates with HVPG and independently predict clinical outcomes. Three simple markers i.e. platelet count, IR assessed by HOMA-IR and adiponectin significantly predict the presence of esophageal varices in cirrhotic patients.
authors.affiliation: Unit for The Clinical Management of Digestive Diseases and CIBERehd, Hospital Universitario de Valme, Sevilla, Spain.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Eslam
authors.forename: Javier
authors.initials: J
authors.lastname: Ampuero
authors.forename: Maria
authors.initials: M
authors.lastname: Jover
authors.forename: Hesham
authors.initials: H
authors.lastname: Abd-Elhalim
authors.forename: Diego
authors.initials: D
authors.lastname: Rincon
authors.forename: Mohammed
authors.initials: M
authors.lastname: Shatat
authors.forename: Ines
authors.initials: I
authors.lastname: Camacho
authors.forename: Amal
authors.initials: A
authors.lastname: Kamal
authors.forename: Oreste
authors.initials: O
authors.lastname: Lo Iacono
authors.forename: Zainb
authors.initials: Z
authors.lastname: Nasr
authors.forename: Lourdes
authors.initials: L
authors.lastname: Grande
authors.forename: Rafael
authors.initials: R
authors.lastname: Banares
authors.forename: Mahmoud A
authors.initials: MA
authors.lastname: Khattab
authors.forename: Manuel
authors.initials: M
authors.lastname: Romero-Gomez
mesh_terms: D052242:Adiponectin / Q000097:blood*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis*; D016009:Chi-Square Distribution; D004534:Egypt; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D014690:Venous Pressure
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin